Provider Demographics
NPI:1265824205
Name:DR. JEFFREY TARANTO EYECARE, A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DR. JEFFREY TARANTO EYECARE, A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TARANTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-761-3379
Mailing Address - Street 1:12214 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2518
Mailing Address - Country:US
Mailing Address - Phone:818-761-3379
Mailing Address - Fax:818-761-7635
Practice Address - Street 1:12214 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2518
Practice Address - Country:US
Practice Address - Phone:818-761-3379
Practice Address - Fax:818-761-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty